EFORT Open Rev. 2025 Oct 1;10(10):815-828. doi: 10.1530/EOR-2025-0041.

ABSTRACT

OBJECTIVE: Primary spondylodiscitis poses significant diagnostic and therapeutic challenges, with delayed diagnosis or improper treatment potentially resulting in severe complications. This systematic review aimed to summarize the latest diagnostic and therapeutic approaches for primary spondylodiscitis.

METHODS: Adhering to PRISMA 2020 guidelines, we conducted a systematic literature review. PubMed was comprehensively searched for English-language original studies from January 1, 1990, to October 31, 2024. Structured queries combined keywords and MeSH terms relevant to spondylodiscitis, vertebral osteomyelitis, spinal infection, and associated treatments. Two reviewers independently screened titles, abstracts, and full texts, with manual bibliography searches as a supplement. A total of 147 articles were finally included.

RESULTS: The literature indicates that diagnosis can be based on clinical suspicion, using serological, radiological, and microbiological tests. Newer methods such as metagenomics next-generation sequencing (mNGS) and positron emission tomography-computed tomography (PET-CT) can enhance diagnostic sensitivity and specificity. For confirmed cases, appropriate antibiotic therapy is crucial. Surgical treatment can benefit patients with neurological deficits, sepsis, spinal instability/deformity, epidural abscesses, or failed conservative treatment, accelerating recovery and reducing complications. Minimally invasive surgical approaches may also serve as an alternative to open surgery for select patients.

CONCLUSION: Although new technologies have improved diagnostic accuracy and treatment success rates for primary spondylodiscitis, establishing a robust staging system is vital to ensure patients receive effective, evidence-based treatment options.

PMID:41031628 | PMC:PMC12495883 | DOI:10.1530/EOR-2025-0041

EFORT Open Rev. 2025 Oct 1;10(10):756-762. doi: 10.1530/EOR-2024-0179.

ABSTRACT

PURPOSE: The surgical reconstruction of the medial patellofemoral ligament (MPFL) is a commonly used treatment for recurrent patellar dislocations. A surgical method which is frequently used is the dynamic reconstruction of the MPFL (dMPFLr), which involves attaching the released end of a hamstring muscle to the medial patella using a pulley. The aim of this systematic review and meta-analysis is to evaluate the evidence of this method in terms of patient-reported outcomes, the rate of recurrent instabilities, and other complications.

METHODS: MEDLINE® and Web of Science™ were used to identify eligible studies. We used a random-effects meta-analysis to estimate the pooled rates of the Kujala scores, rates of recurrent instabilities, and complication rates.

RESULTS: A total of 1,087 studies were screened for eligibility. Six studies, comprising a total of 267 treated knees, met the inclusion criteria and were included. All the publications included were retrospective analyses (level of evidence III). The random-effects model showed an overall mean postoperative Kujala score of 86.74 (95% CI: 79.37-94.11; heterogeneity: I 2 = 94%), a recurrent instability rate of 13% (95% CI: 9-18%; heterogeneity: I 2 = 0%), and additional complications mentioned at a rate of 9% (95% CI: 5-16%; heterogeneity: I 2 = 0%).

CONCLUSION: Although good results are achieved with regard to the patient-reported outcomes and complication rates, there is a high rate of recurrent instabilities. Despite these results, dMPFLr can be considered an option for the treatment of skeletally immature patients, as it avoids the need for intraoperative fluoroscopy and the risk of epiphyseal joint injury due to femoral fixation.

PMID:41031627 | PMC:PMC12494057 | DOI:10.1530/EOR-2024-0179

EFORT Open Rev. 2025 Oct 1;10(10):782-795. doi: 10.1530/EOR-2025-0022.

ABSTRACT

PURPOSE: To quantify the response to intra-articular saline administration in terms of pain, function, and quality of life, with a focus on the evolution of placebo response over time and the identification of influencing factors on the placebo response to knee osteoarthritis injections.

METHODS: After registration on PROSPERO, a systematic review was conducted following PRISMA guidelines to identify double-blind, placebo-controlled randomised clinical trials on intra-articular knee injections for knee osteoarthritis. The placebo response was evaluated through meta-analyses of VAS pain, WOMAC, KOOS, and responder rates at 1-, 3-, 6-, and 12-months on placebo arms of included trials. The evolution of placebo response over time was assessed, and meta-regression was conducted. Risk of bias and quality of evidence were assessed following Cochrane guidelines.

RESULTS: From the initial 2,746 records, 73 articles on 5,895 patients were included. The meta-analysis demonstrated statistically and clinically significant improvements at the 1-, 3-, and 6-month follow-ups. At the 12-month follow-up, placebo response declined and was no longer clinically significant for some sub-scores. Responder rates exceeded 50% at 1-, 3-, and 6-months. The placebo response was stronger in studies with a higher proportion of female participants and in more recently published trials.

CONCLUSIONS: Placebo response to intra-articular injections is statistically and clinically significant in knee osteoarthritis for pain, function improvement, and patients' quality of life, with responses peaking at 4-8 months but evidence up to 12 months. Among influencing factors, female sex and recent publications seem to present stronger placebo responses, emphasising the importance of placebo-controlled trials to evaluate knee osteoarthritis treatments.

PMID:41031623 | PMC:PMC12495556 | DOI:10.1530/EOR-2025-0022

EFORT Open Rev. 2025 Oct 1;10(10):806-814. doi: 10.1530/EOR-2025-0010.

ABSTRACT

Teardrop fractures of the cervical spine are characterized by a triangular-shaped fragment located in the anteroinferior corner of the vertebral body. Flexion-type teardrop fractures are highly unstable injuries resulting from a flexion-compression mechanism. A notable feature of these injuries is retrolisthesis of the vertebral body, which is often associated with a high risk of neurological compromise. The anterior approach is the most commonly used surgical treatment for flexion-type teardrop fractures. In contrast, extension-type teardrop fractures primarily affect the axis vertebral body and are generally stable injuries that can be treated nonoperatively.

PMID:41031621 | DOI:10.1530/EOR-2025-0010

EFORT Open Rev. 2025 Oct 1;10(10):745-755. doi: 10.1530/EOR-2024-0155.

ABSTRACT

This review presents a standardized, stepwise method for biplanar radiographic analysis of knee alignment, integrating both coronal and sagittal measurements for use in arthritic and non-arthritic knees. It critically compares leading classification systems, including the coronal plane alignment of the knee (CPAK) and the functional knee phenotype classifications. While CPAK provides a simplified 2D coronal model, the functional phenotype system offers a more granular, 3D approach that includes segmental deformities and has recently been expanded to incorporate laxity parameters. Sagittal plane parameters - including posterior tibial slope and femoral component flexion/extension - are essential for comprehensive alignment assessment. These factors influence implant positioning, knee kinematics, and postoperative function. The review outlines preferred measurement techniques, highlighting the value of long-leg weight-bearing radiographs and discussing the limitations and variability of 2D versus 3D imaging approaches. Incorporating both alignment and soft tissue behavior provides a more individualized approach to total knee arthroplasty planning and may lead to improved outcomes by better replicating native knee biomechanics.

PMID:41031620 | PMC:PMC12494059 | DOI:10.1530/EOR-2024-0155

EFORT Open Rev. 2025 Oct 1;10(10):726-732. doi: 10.1530/EOR-2024-0056.

ABSTRACT

PURPOSE: To synthesize and critically appraise the literature on long-term outcomes of proximal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis and to assess the long-term HV recurrence rates of studies with a minimum follow-up of 5 years.

METHODS: This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of proximal osteotomies of the M1 for non-inflammatory and non-degenerative HV at a minimum follow-up of 5 years were included. We found four eligible studies comprising four datasets, and all assessed proximal osteotomies with a mean follow-up that ranged from 8 to 18 years.

RESULTS: The systematic search returned 7,918 records, of which 2,693 were duplicates, leaving 5,225 for screening. Of these, four studies were included, covering a total of 158 feet with a mean follow-up that ranged from 8 to 18 years. The pooled HVA following proximal osteotomies was 20.4° (CI: 11.3°-29.4°; I 2 = 95%), pooled IMA was 8.8° (CI: 3.3°-14.2°; I 2 = 98%), and pooled AOFAS was 82.1 (CI: 62.4-101.8; I 2 = 97%).

CONCLUSIONS: At a minimum follow-up of 8 years following proximal osteotomies of M1, the HVA was 20.4° and the IMA was 8.8°. Furthermore, the recurrence rates considering the various thresholds of HVA were 12% having >30°, 73% having >20°, and 13% if recurrence is a >10° increase in HVA.

LEVEL OF EVIDENCE: Meta-analysis, level IV.

PMID:41031617 | PMC:PMC12493268 | DOI:10.1530/EOR-2024-0056

EFORT Open Rev. 2025 Oct 1;10(10):763-770. doi: 10.1530/EOR-2024-0213.

ABSTRACT

In patients with knee osteoarthritis, tibial stress fractures are mostly associated with osteoporosis and lower limb malalignment. Nonoperative management may lead to knee stiffness (due to prolonged immobilization), persistence of pain (due to the underlying knee osteoarthritis), and fracture nonunion. Acute unstable tibial stress fractures can be managed with long-stem total knee arthroplasty. Exposing the fracture site should be avoided as much as possible because it may be associated with skin necrosis and delayed union. In irreducible cases or fractures with persistent gaps, fibular osteotomy, by increasing the mobility and compression across the fracture site, may help with fracture reduction and decrease the rate of nonunion.

PMID:41031615 | PMC:PMC12494058 | DOI:10.1530/EOR-2024-0213

J Bone Joint Surg Am. 2025 Oct 1;107(19):e96. doi: 10.2106/JBJS.25.00711. Epub 2025 Oct 1.

NO ABSTRACT

PMID:41032024 | DOI:10.2106/JBJS.25.00711

J Bone Joint Surg Am. 2025 Oct 1;107(19):e95. doi: 10.2106/JBJS.25.00703. Epub 2025 Oct 1.

NO ABSTRACT

PMID:41032023 | DOI:10.2106/JBJS.25.00703

J Bone Joint Surg Am. 2025 Oct 1;107(19):e94. doi: 10.2106/JBJS.25.00395. Epub 2025 Oct 1.

NO ABSTRACT

PMID:41032022 | DOI:10.2106/JBJS.25.00395

J Bone Joint Surg Am. 2025 Oct 1;107(19):2216-2219. doi: 10.2106/JBJS.25.00505. Epub 2025 Aug 12.

NO ABSTRACT

PMID:41032021 | DOI:10.2106/JBJS.25.00505

Int Orthop. 2025 Oct 1. doi: 10.1007/s00264-025-06661-7. Online ahead of print.

ABSTRACT

PURPOSE: In shoulder arthroplasty, three-dimensional computed tomography (3D CT) has become the gold standard for preoperative version assessment. Meanwhile, postoperative version is usually evaluated using radiographs (XR), in particular an axillary view, in which the view of the scapular body is often truncated, preventing the scapular plane from being used as a reference. This study introduces the posterolateral acromion-to-coracoid (PLAC) line, which can be assessed on a standard truncated axillary radiograph.

MATERIALS AND METHODS: Forty-six shoulders were studied. Four angles were measured including 3D CT (CT Version), 3D CT PLAC line to glenoid face angle (CT PLAC-GFA), 2) radiographic PLAC line to glenoid face angle (XR PLAC-GFA), and 3) the radiographic glenoid vault line to glenoid face angle (XR GV-GFA). Variation and linear relationship between these angles were calculated.

RESULTS: The mean difference between CT PLAC-GFA and XR PLAC-GFA was 1.0º (95% CI -0.7 to 2.8)(IQR = 8.5º, -3.0º to 5.4º), with a strong correlation on linear regression (R2 = 0.76, p < 0.001). XR PLAC-GFA and XR GV-GFA demonstrated strong correlations with CT measured version (R2 = 0.72 and 0.70, respectively; p < 0.001). Inter-rater reliability was excellent for all metrics (ICC ≥ 0.93).

CONCLUSIONS: The PLAC and the glenoid vault lines are highly reproducible references on truncated axillary views. These alternative reference lines allow accurate comparison of preoperative and postoperative glenoid orientation using standard axillary radiographs.

PMID:41032114 | DOI:10.1007/s00264-025-06661-7

Int Orthop. 2025 Oct 1. doi: 10.1007/s00264-025-06664-4. Online ahead of print.

ABSTRACT

BACKGROUND: Posturography is a diagnostic technique that quantifies postural control through Centre of Pressure (CoP) displacement analysis on a force platform. Footwear characteristics, particularly heel-to-toe drop, may influence balance by modifying plantar pressure distribution and proprioceptive feedback. The aim of this study was to evaluate the impact of different footwear drops (0 mm, 5 mm, 10 mm) on postural control in healthy young adults, considering sex, BMI, and shoe size.

METHODS: A cross-sectional study was conducted in 117 participants (56 men, 61 women) using the Dinascan/IBV® platform and the Romberg test. CoP displacement and velocity were analyzed.

RESULTS: Significant differences were observed in CoP total displacement (p < 0.001), mean velocity (p < 0.001), and medio-lateral dispersion (p = 0.024) when comparing 0 mm to 5 mm and 10 mm drops. Sex differences were significant at 0 mm drop for maximum medio-lateral force (p < 0.001) and mean velocity (p = 0.042), with men exhibiting greater values. At 5 mm drop, men showed significantly higher swept area (p = 0.029) and anteroposterior displacement (p = 0.007) than women.

CONCLUSIONS: Small variations in footwear drop can affect postural control, particularly in the medio-lateral plane. Sex and BMI significantly influence CoP behavior, suggesting the need to consider these factors in footwear design and clinical balance assessments.

PMID:41032113 | DOI:10.1007/s00264-025-06664-4

Injury. 2025 Sep 23:112772. doi: 10.1016/j.injury.2025.112772. Online ahead of print.

ABSTRACT

BACKGROUND: While domestic violence (DV) - encompassing abusive action towards children, intimate partners, and elderly patients - is frequently reported at US trauma centers each year, contemporary data on DV trends and outcomes remain limited.

METHODS: We identified all trauma patients with DV using the 2018-2021 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database. Temporal trends were analyzed using the Cochran-Armitage test. Multivariable logistic and linear regression models were used to assess the association of DV with in-hospital mortality, hospital duration of stay (LOS) and non-home discharge.

RESULTS: Among 4190,728 trauma admissions, 8677 (0.2 %) involved DV, with the majority being children (73.6 %), followed by adults (19.5 %) and elderly patients (7.0 %). DV-related trauma admissions increased significantly from 2018 to 2021 (1.7 to 2.0 per 1000 trauma admissions, trend test P < 0.001). DV victims were more frequently female (48.8 vs 39.0 %), Black (30.7 vs 15.2 %), and insured by Medicaid (61.8 vs 18.0 %). DV was associated with higher in-hospital mortality among children (AOR 4.86, 95 % CI 3.88-6.10) and elderly patients (AOR 2.59, 95 % CI 1.42-4.73). Children with DV had significantly longer LOS by 2.1 days (95 % CI 1.8-2.4 days). Children (AOR 2.98, 95 %CI 2.30-3.85) and elderly DV patients (AOR 1.60, 95 %CI 1.15-2.23) had increased odds of non-home discharge.

CONCLUSION: DV-related trauma admissions have risen significantly across national trauma centers. Enhanced protocols at trauma centers may provide critical opportunities for DV identification and intervention as well as prevention strategies.

PMID:41033958 | DOI:10.1016/j.injury.2025.112772

Injury. 2025 Sep 23;56(11):112771. doi: 10.1016/j.injury.2025.112771. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the feasibility and efficacy of longitudinal bending measurements to monitor the progression of fracture healing. Standard methods for evaluating bone healing rely on the assessment of radiographs, which is subjective in nature and intractable during the first several weeks of healing due to the delayed timeframe of radiographically visible mineralization. In contrast, bending measurements can provide a direct objective measurement of fracture stability that is sensitive to soft callus formation during the acute healing phase.

METHODS: In this study, a direct electromagnetic coupling (DEC) sensing system, which measures bending compliance, was evaluated in an exploratory observational study of diaphyseal tibial fracture patients. Longitudinal measurements were obtained from five patients at their clinical visits and remotely from 14 patients in their homes.

RESULTS: The DEC bending data satisfied repeatability criteria of less than 10 % precision error in 12 of 14 remote patients. As expected, bending compliance decreased with time for 17 of 18 fractures that resulted in union. One fracture resulted in non-union, and the corresponding bending compliance increased with time. The bending compliance rate of change, determined as early as 4 weeks post-injury, detected significant differences between patients with and without non-steroidal anti-inflammatory drug (NSAID) use and between patients with and without co-morbidities.

CONCLUSIONS: These results demonstrated the feasibility of remote bending measurements using DEC, which provide a precise metric of early fracture healing rate that may be invaluable for clinical patient management and as an outcome measure in clinical research.

PMID:41033087 | DOI:10.1016/j.injury.2025.112771

SICOT J. 2025;11:56. doi: 10.1051/sicotj/2025051. Epub 2025 Sep 30.

ABSTRACT

BACKGROUND: Ankle pain frequently occurs in patients with medial compartment knee osteoarthritis (OA), particularly in those with varus deformity. In these patients, an atypical alignment of the ankle joint line relative to the ground is often observed in the coronal plane. The purpose of this study was to evaluate changes in ankle pain and ankle joint orientation after high tibial osteotomy as a treatment of medial compartment knee OA.

METHODS: This prospective work was conducted on 100 patients, aged 40-55 years old, with symptomatic medial compartment knee OA associated with ankle pain, with a good range of motion and intact lateral compartment. All patients treated with high tibial osteotomy fixed by plate. Ankle pain was measured by visual analogue score (VAS) preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. The following parameters were assessed preoperatively and at 3 months postoperatively: the ankle joint line orientation (AJLO), medial proximal tibial angle (MPTA), and the hip-knee-ankle angle (HKA).

RESULTS: The ankle pain significantly improved postoperatively and at last follow-up after HTO; VAS significantly reduced from 5 (4-5) preoperatively to 2 (1-2) at last follow-up (P < 0.001). AJLO was substantially decreased from 9.58 ± 2.74° preoperative to 0.41 ± 1.88° postoperative (P < 0.001). MPTA increased significantly following surgery, from a preoperative value of 85.78 ± 1.84° to a postoperative value of 90.71 ± 1.58° (P < 0.001). Similarly, HKA improved significantly from -7.73 ± 1.50° preoperatively to 2.43 ± 0.88° postoperatively (P < 0.001). A positive correlation was found between ankle pain improvement via VAS and changes in AJLO, MPTA, and HKA (P < 0.05).

CONCLUSION: In patients with medial unicompartmental knee OA associated with ankle pain, both ankle pain and ankle joint orientation improved following high tibial osteotomy.

PMID:41026917 | PMC:PMC12483354 | DOI:10.1051/sicotj/2025051

SICOT J. 2025;11:55. doi: 10.1051/sicotj/2025054. Epub 2025 Sep 30.

ABSTRACT

PURPOSE: This study aimed to assess hindfoot height (HFH) changes 12 months after posterior arthroscopic subtalar arthrodesis without bone grafting. We hypothesized that HFH reduction would be minimal and would not impact fusion or functional results.

METHODS: A retrospective study was conducted on 39 patients who underwent posterior arthroscopic subtalar arthrodesis. HFH was measured on CT scans preoperatively and at 12 months postoperatively. Inter- and intra-observer reliability of the measurement was also assessed as a secondary outcome. Clinical outcomes included pain (numeric analog scale, NAS) and AOFAS Ankle-Hindfoot scores. Subtalar fusion ratios were evaluated via CT.

RESULTS: Mean HFH loss was 0.85 ± 1.1 mm (range, 0-5 mm). The average fusion ratio was 72 ± 30%. Pain and AOFAS scores significantly improved (NAS: -4 ± 2, p < 0.0001; AOFAS: +31 ± 13, p < 0.0001). No correlation was found between HFH loss and fusion ratio or clinical outcomes. HFH loss > 1 mm was more frequent in women and smokers. HFH measurement on CT showed excellent inter- and intra-observer reliability (ICC intra: 0.989; inter: 0.976).

CONCLUSIONS: Posterior arthroscopic subtalar arthrodesis without bone graft results in minimal hindfoot height loss, with no negative impact on subtalar fusion or functional outcomes. This technique reliably preserves hindfoot alignment and provides excellent clinical results. While the assessment of hindfoot height on CT demonstrated excellent inter- and intra-observer reliability, this was a secondary finding and supports the utility of CT-based measurements in the postoperative evaluation of subtalar arthrodesis.

PMID:41026916 | PMC:PMC12483349 | DOI:10.1051/sicotj/2025054

Int Orthop. 2025 Sep 30. doi: 10.1007/s00264-025-06634-w. Online ahead of print.

NO ABSTRACT

PMID:41026200 | DOI:10.1007/s00264-025-06634-w

Int Orthop. 2025 Sep 29. doi: 10.1007/s00264-025-06639-5. Online ahead of print.

ABSTRACT

This study evaluated the outcomes of double mobility trapeziometacarpal prostheses for treating osteoarthritis (OA) of the trapeziometacarpal (TMC) joint. A prospective observational analysis was conducted on 150 implants with a maximum follow-up of four years, including a clinical and radiographic assessment and an evaluation of complications. The results indicate a prosthesis survival rate of 97.9% after the first two years post-surgery, calculated using the Kaplan-Meier method. Significant improvements were observed in pain reduction (mean VAS at 3 months post-surgery 2,9 and 1.5 after 6 months), hand grip strength (25.93 kg at 6 months post-surgery), and range of motion (Kapandji score from 8.8 to 9.2, comparing the preoperative mean with the mean after the first postoperative month). The complication rate was low, with only two cases of cup migration and one case of trapezium resorption. Patient satisfaction was high due to the rapid functional recovery and reduced invasiveness compared to traditional techniques. Double-mobility prostheses offer a highly effective treatment for stage II and III TMC OA according to the Eaton-Littler classification, with minimal need for revision surgeries.

PMID:41020960 | DOI:10.1007/s00264-025-06639-5

Int Orthop. 2025 Sep 29. doi: 10.1007/s00264-025-06663-5. Online ahead of print.

ABSTRACT

PURPOSE: Calcium pyrophosphate dihydrate (CPPD) deposition, often visible radiographically as chondrocalcinosis, frequently accompanies knee osteoarthritis and is usually encountered at the time of arthroplasty. Whether its presence influences the outcome of patellofemoral arthroplasty (PFA) remains uncertain.

METHODS: We reviewed 100 PFAs performed in 82 patients between 1997 and 2005, and followed them for an average of 22 years (range, 20-25 years). At surgery, 35 knees showed radiographic chondrocalcinosis, and an additional 33 developed calcification during follow-up.

RESULTS: Fifteen knees (15%) required revision to total knee arthroplasty (TKA) at a mean of 12 years after PFA. The main reasons for revision were tibiofemoral osteoarthritis progression (6 knees), patellar malalignment (7 knees), one implant loosening, and one patella fracture. The 20-year survival rates were 87% for knees without chondrocalcinosis and 90% for those with chondrocalcinosis, with no significant difference in revision timing between groups (log-rank p = 0.64).

CONCLUSION: Although chondrocalcinosis became more prevalent with age and follow-up, it did not increase the risk of conversion to TKA. These findings suggest that PFA remains a suitable option in carefully selected patients, regardless of the presence of chondrocalcinosis.

PMID:41020959 | DOI:10.1007/s00264-025-06663-5